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What a drag … Iceland considers prescription-only cigarettes

Tobacco bill proposes outlawing shop sales, with only doctors allowed to prescribe cigarettes to addicts unable to kick habit


Helen Pidd
guardian.co.uk, Monday 4 July 2011 12.35 BST

Iceland considering cigarette ban
Iceland is considering banning the shop sale of cigarettes to help society 'wake up' to the dangers of smoking.

Iceland is considering banning the sale of cigarettes and making them a prescription-only product.

The parliament in Reykjavik is to debate a proposal that would outlaw the sale of cigarettes in normal shops. Only pharmacies would be allowed to dispense them – initially to those aged 20 and up, and eventually only to those with a valid medical certificate.

The radical initiative is part of a 10-year plan that also aims to ban smoking in all public places, including pavements and parks, and in cars where children are present. Iceland also wants to follow Australia's lead by forcing tobacco manufacturers to sell cigarettes in plain, brown packaging plastered with health warnings rather than branding.

Under the mooted law, doctors will be encouraged to help addicts kick the habit with treatments and education programmes. If these do not work, they may prescribe cigarettes.

The private member's bill is sponsored by former health minister Siv Fridleifsdottir, who worked with the Icelandic Medical Association as well as a coalition of anti-tobacco groups to come up with the proposal. "The aim is to protect children and youngsters and stop them from starting to smoke," she said on Monday. The proposal would initially result in an increase in cigarette prices, said Fridleifsdottir, of "10% per year, in line with World Health Organisation proposals – evidence shows that a 10% increase results in a 4-8% reduction in consumption".

But by the end of the 10-year plan, prescription-only cigarettes should actually be cheaper than ever, according to Thorarinn Gudnason, president of the Icelandic Society of Cardiology, who helped draw up the proposal.

"Under our plan, smokers who are given prescriptions will be diagnosed as addicts, and we don't think the government should tax addicts."

Gudnason said current cigarette pricing in Iceland did not take into account the huge costs imposed on society by smokers. "A packet currently costs around 1,000 krona [£5.50], but if you factor in the cost of sick leave, reduced productivity due to smoking breaks and premature retirement on health grounds, it should really be 3,000 krona," he said.

The tobacco proposal also says that nicotine should be classed as an addictive substance. "It's as hard to give up nicotine as heroin, not in terms of the side effects, but in terms of the cravings and how quickly one becomes addicted," said Gudnason.

"We also want the government to license cigarettes like a medicine, which would mean they would have to go through the same rigorous trials as any other drug. I doubt cigarettes would ever get on the market now that we know the side-effects – lung cancer, heart attacks, chronic obstructive pulmonary disease."

Gudnason said 300 out of the 1,500 deaths in Iceland each year were caused by one of those three conditions.

"That's 20% of all deaths. We think that our proposals could lead to a significant reduction in smoking-related deaths – perhaps down to just 100 annually."

The proposal also suggests that tobacco smoke should be treated as a carcinogenic substance, and that it should be restricted in a similar way to other known carcinogens, because of the known effects of passive smoking.

Gudnason did a study five months after Iceland introduced a smoking ban in restaurants and pubs in 2007 and found a 21% reduction in acute coronary syndrome (heart attacks and near heart attacks) among non-smoking men, compared to five months before the ban.

A spokeswoman from the Icelandic ministry of welfare said on Monday that the proposal was "very serious" but had limited chances of success.

"Siv Fridleifsdottir is a very serious politician and this is a very serious proposal," said Anna Baldursdottir, political adviser to the minister of welfare, Gudbjartur Hannesson.

"Whether it not it eventually becomes law, I do not know. I seriously doubt it."

The idea will be debated in the Althing, Iceland's parliament, in the autumn, when politicians return from recess, she added.

Iceland has successfully halved smoking rates over the past 20 years. In 1991, 30% of the population smoked; today, only about 15% light up regularly, according to Baldursdottir, giving it the lowest smoking rates in Europe.

This success is attributed to huge increases in tobacco tax, which accounts for about 25% of the pack price, as well as the drop in disposable income among islanders since the financial crash of 2008.

Other countries have gone further. Bhutan has completely outlawed smoking and Finland hopes to follow suit by 2040.

Swedish surgeons now refuse to operate on smokers until they give up, because of the deleterious effect smoking has on the healing process, Gudnason added.

As an isolated island, Iceland arguably stands a greater chance of success with such draconian measures than other nations.

With no neighbouring countries and rigid customs controls at ports and airports, it will be difficult for anyone to smuggle in contraband cigarettes.

BigJKU316 wrote:Iceland might be able to get away with it, as isolated as they are.

The rest of the world would be facing prohibition in the US during the 20's style conditions pretty quickly I would think. Suddenly there would be huge criminal money to be made selling something that was previously legal. Sounds like a really dumb idea.

Tyyr wrote:I dunno, I have trouble imagining a significant underground cigarette black markets popping up. Especially since tobacco plants have one use and one use only. It's not like a farmer running a still on the side where his crop is perfectly legit and his still can be hidden in a barn. To produce tobacco in the quantity necessary to sell them at a decent price is going to be conspicuous. I think a lot of people when faced with the prospect of $5 a pop cigarettes will just choose to quit.

Giuseppe wrote:

BigJKU316 wrote:Iceland might be able to get away with it, as isolated as they are.

The rest of the world would be facing prohibition in the US during the 20's style conditions pretty quickly I would think. Suddenly there would be huge criminal money to be made selling something that was previously legal. Sounds like a really dumb idea.

I completely agree.

Still... cigarettes being completely illegal is probably the only way I'll ever quit.

Mikey wrote:Yeah, because growing cannabis sativa is illegal, and that's pretty much put a stop to illegal weed sales, right?

Tyyr wrote:

Mikey wrote:Yeah, because growing cannabis sativa is illegal, and that's pretty much put a stop to illegal weed sales, right?

Yeah because aside from rolling papers those two are dead ringers for one another.

1) The buzz you get from THC isn't comparable to anything you get from tobacco aside from the craving mollification.
2) The number of cigarette smokers in the US dwarfs the number of pot smokers in shear number and volume. It's far easier to keep a pot smoker supplied who only lights up a single joint two or three times a week than a cigarette smoker who goes through a pack a day. And THC isn't physically addictive like nicotine is so a pot smoker is far easier looking at their empty wallet and abstaining for a day or two than a cigarette smoker is. Simply put tobacco isn't something that's going to be able to be hidden in grow houses like pot, not and supply the shear volume it would take to keep smokers happy. Ergo the price is going to be very high. When you go from $5 a pack to $5 a cigarette it's going to force a lot of people out of the habit.

I'm not suggesting that it will disappear but alcohol and cigarettes are two different things and the effect of outlawing one isn't necessarily going to be the same as outlawing the other.

I have trouble imagining a significant underground cigarette black markets popping up

Tyyr wrote:

Mikey wrote:Yeah, because growing cannabis sativa is illegal, and that's pretty much put a stop to illegal weed sales, right?

Yeah because aside from rolling papers those two are dead ringers for one another.

1) The buzz you get from THC isn't comparable to anything you get from tobacco aside from the craving mollification.
2) The number of cigarette smokers in the US dwarfs the number of pot smokers in shear number and volume. It's far easier to keep a pot smoker supplied who only lights up a single joint two or three times a week than a cigarette smoker who goes through a pack a day. And THC isn't physically addictive like nicotine is so a pot smoker is far easier looking at their empty wallet and abstaining for a day or two than a cigarette smoker is. Simply put tobacco isn't something that's going to be able to be hidden in grow houses like pot, not and supply the shear volume it would take to keep smokers happy. Ergo the price is going to be very high. When you go from $5 a pack to $5 a cigarette it's going to force a lot of people out of the habit.

I'm not suggesting that it will disappear but alcohol and cigarettes are two different things and the effect of outlawing one isn't necessarily going to be the same as outlawing the other.

shran wrote:Swedish surgeons now refuse to operate on smokers until they give up, because of the deleterious effect smoking has on the healing process, Gudnason added.